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Published on: June 11, 2012
Hyperglycemia in the critically ill
Colleen Digman1, Dara Borto, Stanley A Nasraway
1Department of Medicine, Tufts-New England Medical Center and the Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
Summary
Stress hyperglycemia in critically ill patients is linked to worse outcomes. Intensive insulin therapy to normalize blood glucose (euglycemia) can reduce mortality and morbidity in these patients.
Area of Science:
- Critical Care Medicine
- Endocrinology
- Metabolic Disorders
Background:
- Hyperglycemia (high blood sugar) is common in acutely ill patients, often considered a stress response.
- Historically, treatment was delayed until blood glucose levels exceeded 200-250 mg/dL.
- Emerging evidence links hyperglycemia to adverse outcomes in intensive care unit (ICU) patients.
Purpose of the Study:
- To review the association between hyperglycemia and poor outcomes in critically ill patients.
- To discuss the mechanisms contributing to hyperglycemia in this population.
- To highlight the benefits of intensive insulin therapy for managing hyperglycemia.
Main Methods:
- Review of recent evidence and studies on hyperglycemia in medical and surgical ICUs.
- Analysis of physiological mechanisms causing hyperglycemia, including increased gluconeogenesis and insulin resistance.
- Examination of studies evaluating intensive insulin therapy for glycemic control.
Main Results:
- Hyperglycemia in critically ill patients is associated with worse clinical outcomes.
- Potential mechanisms include mitochondrial dysfunction, glucose toxicity, and immune impairment.
- Intensive insulin therapy to achieve euglycemia has been shown to reduce mortality and morbidity.
Conclusions:
- Hyperglycemia in critically ill patients is not merely a stress response but a detrimental condition.
- Understanding the mechanisms of hyperglycemia is crucial for effective management.
- Intensive insulin therapy is a key intervention to improve outcomes in critically ill patients with hyperglycemia.
- Identifying and managing contributing factors like medications and nutrition is also vital.
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